Abstract Esthesioneuroblastoma (ENB), or olfactory neuroblastoma, is a rare malignant neoplasm of neuroectodermal origin that typically arises from the upper nasal cavity near the cribriform plate. Due to its nonspecific symptoms, the diagnosis is usually delayed. During pregnancy, the symptoms due to ENB overlap with the other physiological gestational complaints. We present a rare case involving a 29-year old woman at 32 weeks of gestation who reported progressive frontal headaches, nasal obstruction, and intermittent nasal bleeding. Her condition worsened to include vomiting, altered consciousness, and a seizure episode. Imaging confirmed the presence of a large sinonasal mass occupying left nasal cavity, with significant intracranial extension in the frontal lobe leading to effacement of nearby sulcal spaces, a midline shift to the right, and falcine herniation with compression of the lateral ventricle. Neurological symptoms of altered mental status, seizures, and presence of bilateral papilledema on fundoscopy suggested elevated intracranial pressure requiring urgent decompressive intervention. A multidisciplinary team decided on an elective caesarean section, followed by staged surgical resection through bifrontal craniotomy and trans nasal endoscopic surgery. Histopathological and immunohistochemical analysis confirmed ENB. Postoperative recovery was uneventful, and the patient subsequently underwent adjuvant radiotherapy. At 1-year follow-up, there was no radiological or clinical evidence of disease recurrence, and both maternal and neonatal outcomes were favorable. This case emphasizes the importance of maintaining a high index of suspicion for neoplastic causes in pregnant patients presenting with atypical neurological symptoms. It also highlights the critical role of multidisciplinary coordination in ensuring timely diagnosis and comprehensive management. Early surgical intervention and radiotherapy remain central to the effective treatment of advanced ENB.
Chakravarty et al. (Fri,) studied this question.